Provider Demographics
NPI:1902824360
Name:PLUNDO, LARRY J (DO)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:J
Last Name:PLUNDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 PELLIS ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-832-2570
Mailing Address - Fax:724-832-2521
Practice Address - Street 1:518 PELLIS ROAD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-832-2570
Practice Address - Fax:724-832-2521
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004121L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E69158Medicare UPIN
129027Medicare ID - Type Unspecified